Changing Logics in Healthcare and Their Effects on the Identity Motives and Identity Work of Doctors

Abstract

Recent literature on hybridity has provided useful insights into how professionals have responded to changing institutional logics. Our focus is on how shifting logics have shaped senior medical professionals’ identity motives and identity work in a qualitative study of hospital consultants in the United Kingdom’s National Health Service. We found a binary divide between a large category of traditionalist doctors who reject shifting logics, and a much smaller category of incorporated consultants who broadly accept shifting logics and advocate change, with little evidence of significant ambivalence or temporary identity ‘fixes’ associated with liminality. By developing a new inductively generated framework, we show how the identity motives and identity work of these two categories of doctors differ significantly. We explore the underlying causes of these differences, and the implications they hold for theory and practice in medical professionalism, medical professional leadership and healthcare reform.

Reframing leadership: Leader identity challenges of the emergency physician

“…The multiple modes in which leadership is enacted may further intensify the hybridisation struggles of EPs. 8 In particular, leaders who regard themselves as serendipitous or incidental leaders may face an even stronger sense of diminished credibility, identity confusion and increased internal and external conflict. This is because the experience of hybrid work creates a discrepancy between professional values or identities (i.e.…”

“…Indeed, this is the paradox of EM leadership, flitting in between the liminal states of leadership and followership. 8 In a world where attention screams and authority booms, it is ironic that the best resuscitations are quiet, the backing away of conflict is perceived as weakness and the strongest arms are ones around weak shoulders. Instead of having leadership wielded by or demanded of individuals with formal leadership roles, it is more contextually fitting therefore to expect EM leadership to be co-created by humble-yet-tenacious leaders and critical-yet-supporting followers.…”

Change is never easy: How management theories can help operationalise change in medical education

“…63 Looking at the wider literature, research using an IL perspective has illustrated an inherent struggle between health care managerial logics and medical logics. 39,58 In medical education, similar tensions exist between, for example, service and education provision. 65…”

“…39 Only by doing so can we understand how macro-level understandings of change will connect to and influence interactions at the levels of the individual and the team, and conversely how individuals and teams will have agency to influence and affect at the levels of organisations and systems. 3,39 These multi-level understandings can help explain why organisational changes succeed, fail or have unintended consequences, and will help those involved in change to anticipate and manage uncertainty associated with a change process.…”

“…49 For example, in Western health care, medical professional logics, traditionally embedded in expert knowledge and autonomous practice, has historically governed how health care systems have been viewed and processes of decision making enacted. 39 However, increasing demand for health care provision and reductions in the ability (or inclination) of governments to fund health care in its entirety have led to rises in both managerialism and the influence of market and corporate logics. 50,51 Table 2 provides an example summary of what some of the organisational literature perceives to be the IL at play in health care.…”